Int J Antimicrob Agents. 2021 Jan 20:106284. doi: 10.1016/j.ijantimicag.2021.106284. Online ahead of print.
BACKGROUND: Carbapenem resistant Gram-negative bloodstream infection (CRGNB BSI) has become the most rapidly growing global threat with limited antibiotics options and significant mortality.
OBJECTIVES: To explore the antibiotic strategies and clinical outcomes of patients with CRGNB BSI in western China.
METHODS: We retrospectively investigated the demographic, microbiological and clinical characteristics for 355 patients with CRGNB BSI from 2012 to 2017.
RESULTS: The treatment failure and 28-day in-hospital mortality rates were 49.30% (175/355) and 23.67% (84/355), respectively. The most frequent isolates was Acinetobacter baumannii (58.59%, 208/355). Patients in treatment failure group have higher PCT and IL-6 levels (P<0.05). High-dosage tigecycline therapy (200mg loading dose followed by 100mg every 12h) was not superior to standard dose tigecycline therapy (P>0.05). Multivariable analysis revealed that complicated with MODS (OR, 2.226; 95% CI; 1.376-3.602; P =0.001), admission to ICU (OR, 3.116; 95% CI; 1.905-5.097; P =0.000) were independent risk factors for treatment failure, and monotherapy (OR, 0.386; 95% CI, 0.203-0.735; P =0.000) was a protective effect on treatment failure. Survival analysis revealed that inappropriate therapy, patients with MODS and admission to ICU were associated with a higher 28-day in-hospital mortality rate (P<0.001), but combination therapy was not superior to monotherapy (P=0.387).
CONCLUSIONS: This study demonstrated that appropriate therapy were significantly associated with lower treatment failure rate and 28-day in-hospital mortality. Combination antimicrobial therapy was not preferred over monotherapy. Tigecycline might not a suitable option for CRGBN BSI. Patients with MODS and admitted to ICU had poor clinical outcomes.